Análisis de los factores de riesgo de infección del tracto urinario asociada con sonda vesical en la UCI
Palabras clave:
Factores de riesgo, infecciones urinarias, cateterismo urinario, cuidado intensivo quirúrgicoResumen
Objetivo: Identificar factores de riesgo de infección del tracto urinario en pacientes de cuidado intensivo, con sonda vesical.
Diseño: Estudio de casos y controles.
Localización: Unidad de cuidados intensivos general de adultos, de una clínica no universitaria (Clínica Comfandi-Tequendama, Cali, Colombia).
Métodos: Se empleó el registro del Comité de Vigilancia Epidemiológica para identificar los casos (individuos hospitalizados en la unidad de cuidados intensivos, con sonda vesical como parte de su manejo y en quienes se desarrolló infección del tracto urinario). Del mismo registro se seleccionaron al azar tres controles por cada caso, del grupo de pacientes manejados en la unidad de cuidados intensivos con sonda vesical y que no presentaron infección urinaria.
Mediciones y resultados: Se analizaron 132 pacientes, 33 casos y 99 controles. Se registraron datos demográficos, características de los pacientes y variables del manejo de la sonda.
La distribución por sexos y la severidad del compromiso sistémico, determinada por el APACHE II de las primeras 24 horas, fueron iguales en ambos grupos.
La edad > 74 años, la inserción de la sonda vesical antes del ingreso a la unidad de cuidados intensivos, la duración del cateterismo por más de dos semanas, la coexistencia de peritonitis y el manejo con abdomen abierto se asociaron con mayor riesgo de infección del tracto urinario
El género, la puntuación de APACHE II, la existencia de patología estructural del tracto urinario, los cambios de sonda, la medición de la presión intravesical, la existencia de infecciones diferentes a peritonitis y la administración previa de antibióticos no aumentaron el riesgo.
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Referencias bibliográficas
1. Warren JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am 1997; 11: 609-622.
2. Foxman B. Epidemiology of urinary tract infections. Am J Med 2002; 113: 5S-13S.
3. NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003; 31: 481-498.
4. Ponce de León-Rosales S, Molinar-Ramos F, Domínguez-Cherit G, Rangel-Frausto MS, Vázquez-Ramos VG. Prevalence of infections in intensive care units in México: a multicenter study. Crit Care Med 2000; 28: 1316-1321.
5. Eggiman P, Pittet D. Infection control in the ICU. Chest 2001; 120-128.
6. Bergen GA, Toney JF. Infection versus colonization in the critical care unit. Crit Care Med 1998; 14: 71-90.
7. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study; EPIC International Advisory Committee. JAMA 1995; 274: 639-644.
8. Platt R, Polk BF, Murdock B, Rosner B. Mortality associated with nosocomial urinary-tract infection. New Eng J Med 1982; 307: 637-642.
9. Kollef MH, Sharpless L, Vlaskin J, Pasque C, Murphy D, Fraser VJ. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 1997; 112: 666-675.
10. Osmon S, Warren D, Seiler SM, Shannon W, Fraser VJ, Kollef MH. The influence of infection on hospital mortality for patients requiring >48 h of intensive care. Chest 2003; 124: 121-129.
11. Saint S. Clinical and economic consequences of nosocomial catheter related bacteriuria. Am J Infect Control 2000; 28: 68-75.
12. Tambyah PA, Knasinski V, Maki DG. The direct costs of nosocomial cateter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002; 23: 27-31.
13. Daifuku R, Stamm WE. Association of rectal and urethral colonization with urinary tract infections in patients with indwelling catheters. JAMA 1984; 252: 2028-2030.
14. Garibaldi RA, Burke JP, Britt MR, Miller MA, Smith CB. Meatal colonization and catheter-associated bacteriuria. New Eng J Med 1980; 303: 316-318.
15. Reid G, Denstedt, Kang YS, et al. Microbial adhesion and biofilm formation on urethral stents in vitro and in vivo. J Urol 1992; 148: 1592-1594.
16. Tambyah PA, Maki DG. Catheter- associated urinary tract infection is rarely symptomatic. Arch Intern Med 2004; 160: 678-682.
17. Garibaldi RA, Mooney BR, Epstein BJ, Britt MR. Evaluation of daly bacteriologic monitoring to identify preventable episodes of catheter associated UTI. Infect Control Hosp Epidemiol 1982; 3: 466-470.
18. Maki DG, Knasinski V, Tambay PA. Risk factors for catheter-associated urinary tract infection: a prospective study showing the minimal effects of catheter care violations on the risk of CAUTI (Abstract). Infect Control Hosp Epidemiol 2002; 21: 165.
19. Maki DG, Tambyah PA. Engineering out the risk of infections with urinary catheters. Emerg Infect Dis 2001; 7: 1-7.
20. Shapiro M, Simchen E, Izraeli S, Sacks TG. A multivariate analysis of risk factors for acquiring bacteriuria in patients with indwelling urinary catheters for longer than 24 hours. Infect Control Hosp Epidemiol 1984; 5: 525-532.
21. Platt R, Polk BF, Murdock B, Rosner B. Risk factors for nosocomial urinary tract infection. Amer J Epidemiol 1986; 124: 977-985.
22. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-824.
23. Brosnahan J JATC. Types of urethral catheters for management of short- termnvoiding problems in hospitalized adults (Cochrane Review). in The Cochrane Library 2004; (2).
24. Iberti TJ, Lieber CE, Benjamin E. Determination of intra-abdominal pressure using a transurethral bladder catheter: Clinical validation of the technique. Anesthesiology 1989; 70: 47-50.
25. Marras TK, Nopmaneejumruslers C, Chan CKN. Efficacy of exclusively oral antibiotic therapy in patients hospitalized with nonsevere community-acquired pneumonia: a retrospective study and meta-analysis. Am J Med 2004; 116: 385-393.
26. Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA 2000; 283: 749-755.
27. Solomkin JS, Wilson SE, Christou NV, Rotstein OD, Dellinger EP, Bennion RS, et al. Results of a clinical trial of cliprofloxacin versus imipenem/cilastatin for intraabdominal infections. Ann Surg 2001; 233: 79-87.
28. Solomkin JS, Yellin AE, Rotstein OD, Christou NV, Dellinger EP, Tellado JM, et al. Ertapenem versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections: results of a double-blind, randomized comparative phase III trial. Ann Surg 2003; 237: 235-245.
29. Losanoff JE, Richman BW, Jones JW. Temporary abdominal coverage and reclosure of the open abdomen: frequently asked questions. J Am Coll Surg 2002; 195: 105-115.
30. Ferrada R, Birolini D. New concepts in the management of patients with penetrating abdominal wounds. Surg Clin North Am 1999; 79: 1331-1356.
31. Gowna TA. Transplantation. Am J Kidney Dis 2000; 35: S153-S59.
32. Heidenreich PA, McClellan M. Trends in treatment and outcomes for acute myocardial infarction: 1975-1995. Am J Med 2001; 110: 165-174.
33. American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected acute myocardial infarction or unstable angina. Ann Emerg Med 2000; 35: 521-525.
34. Roberts R. Management of patients with infectious diseases in an emergency department observation unit. Emerg Med Clin North Am 2001; 19: 187-207.
35. Uphold CR, Deloria-Knoll M, Palella FJ, Parada JP, Chmiel JS, Phan L, et al. Management of patients with infectious diseases in an emergency department observation unit. Chest 2004; 125: 548-556.
36. Beaujean DJ, Blok HE, Vanderbroucke-Grauls CM, Weersink AJ, Raimakers JA, Verhoef J. Surveillance of nosocomial infections in geriatric patients. J Hospital Infect 1997; 36: 275-284.
37. Hussain M, Oppenheim PA, O'Neill P, Trembath C, Morris J, Horan MA. Prospective survey of the incidence, risk factors and outcome of hospital-aquired infections in the elderly. J Hosp Infect 1996; 32: 117-126.
38. Shortlife LMD, McCue JD. Urinary tract infections at the age extremes: pediatrics and geriatrics. Am J Med 2002; 113(Suppl 1A): 55S-66S.
39. Hartstein AI, Garber SB, Ward TT, et al. Nosocomial urinary tract infection: a prospective evaluation of 108 catheterized patients. Infect Control Hosp Epidemiol 1981; 2: 380-386.
40. Jain P, Parada JP, David A, et al. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995; 155: 1425-1429.
41. Ouslander JG, Greenhold B, Chen S. Complications of chronic indwelling urinary catheters among male nursing home patients: a prospective study. J Urol 1987; 138: 1191-1195.
42. Ouslander JG, Greenhold B, Silverblatt F, et al. External catheter use and urinary tract infection among incontinent male nursing home patients. J Am Geriatr Soc 1987; 35: 1063-1070.
43. Robert M, Boularan AM, Sandid M, Grasset D. Double-J ureteric stents encrustations: clinical study on crystal formation on polyurethane stents. Urol Int 1997; 58: 100-104.
44. Tambyah PA, Halvorson K, Maki DG. A prospective study of the pathogenesis of catheter-associated urinary tract infection. Mayo Clin Proc 1999; 74: 131-136.
45. Garvey BM, McCambley JA, Tuxen DV. Effects of gastric alkalinization on bacterial colonization in critically ill patients. Crit Care Med 1989; 17(211): 16.
46. Marshall JC, Cristou NV, Meakins JL. The gastrointestinal tract: “the undrained abscess” of multiple organ failure. Ann Surg 1993; 218: 211-216.
47. Warren D, Tenney JH, Hoopes JM, et al. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982; 146: 1535-1537.
48. Warren JW, Antony WC, Hoopes JM, et al. Cephalexin for susceptible bacteriuria in afebrile, long-term catheterized patients. JAMA 1982; 248: 454-458.
49. van der Wall E, Verkooyen RP, Mintjes-de Groot J, Oostinga J, van Dijk A, Hustin VWN. Prophylactic ciprofloxacin for catheter - associated urinary tract infection. Lancet 1992; 339: 946-951.
50. Rutschmann OT, Swahlen H. Use of norfloxacin for prevention of symptomatic urinary tract infection in cronically catheterized patients. Eur J Clin Microbiol Infect Dis 1995; 14: 441-444.
2. Foxman B. Epidemiology of urinary tract infections. Am J Med 2002; 113: 5S-13S.
3. NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003; 31: 481-498.
4. Ponce de León-Rosales S, Molinar-Ramos F, Domínguez-Cherit G, Rangel-Frausto MS, Vázquez-Ramos VG. Prevalence of infections in intensive care units in México: a multicenter study. Crit Care Med 2000; 28: 1316-1321.
5. Eggiman P, Pittet D. Infection control in the ICU. Chest 2001; 120-128.
6. Bergen GA, Toney JF. Infection versus colonization in the critical care unit. Crit Care Med 1998; 14: 71-90.
7. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study; EPIC International Advisory Committee. JAMA 1995; 274: 639-644.
8. Platt R, Polk BF, Murdock B, Rosner B. Mortality associated with nosocomial urinary-tract infection. New Eng J Med 1982; 307: 637-642.
9. Kollef MH, Sharpless L, Vlaskin J, Pasque C, Murphy D, Fraser VJ. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 1997; 112: 666-675.
10. Osmon S, Warren D, Seiler SM, Shannon W, Fraser VJ, Kollef MH. The influence of infection on hospital mortality for patients requiring >48 h of intensive care. Chest 2003; 124: 121-129.
11. Saint S. Clinical and economic consequences of nosocomial catheter related bacteriuria. Am J Infect Control 2000; 28: 68-75.
12. Tambyah PA, Knasinski V, Maki DG. The direct costs of nosocomial cateter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002; 23: 27-31.
13. Daifuku R, Stamm WE. Association of rectal and urethral colonization with urinary tract infections in patients with indwelling catheters. JAMA 1984; 252: 2028-2030.
14. Garibaldi RA, Burke JP, Britt MR, Miller MA, Smith CB. Meatal colonization and catheter-associated bacteriuria. New Eng J Med 1980; 303: 316-318.
15. Reid G, Denstedt, Kang YS, et al. Microbial adhesion and biofilm formation on urethral stents in vitro and in vivo. J Urol 1992; 148: 1592-1594.
16. Tambyah PA, Maki DG. Catheter- associated urinary tract infection is rarely symptomatic. Arch Intern Med 2004; 160: 678-682.
17. Garibaldi RA, Mooney BR, Epstein BJ, Britt MR. Evaluation of daly bacteriologic monitoring to identify preventable episodes of catheter associated UTI. Infect Control Hosp Epidemiol 1982; 3: 466-470.
18. Maki DG, Knasinski V, Tambay PA. Risk factors for catheter-associated urinary tract infection: a prospective study showing the minimal effects of catheter care violations on the risk of CAUTI (Abstract). Infect Control Hosp Epidemiol 2002; 21: 165.
19. Maki DG, Tambyah PA. Engineering out the risk of infections with urinary catheters. Emerg Infect Dis 2001; 7: 1-7.
20. Shapiro M, Simchen E, Izraeli S, Sacks TG. A multivariate analysis of risk factors for acquiring bacteriuria in patients with indwelling urinary catheters for longer than 24 hours. Infect Control Hosp Epidemiol 1984; 5: 525-532.
21. Platt R, Polk BF, Murdock B, Rosner B. Risk factors for nosocomial urinary tract infection. Amer J Epidemiol 1986; 124: 977-985.
22. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-824.
23. Brosnahan J JATC. Types of urethral catheters for management of short- termnvoiding problems in hospitalized adults (Cochrane Review). in The Cochrane Library 2004; (2).
24. Iberti TJ, Lieber CE, Benjamin E. Determination of intra-abdominal pressure using a transurethral bladder catheter: Clinical validation of the technique. Anesthesiology 1989; 70: 47-50.
25. Marras TK, Nopmaneejumruslers C, Chan CKN. Efficacy of exclusively oral antibiotic therapy in patients hospitalized with nonsevere community-acquired pneumonia: a retrospective study and meta-analysis. Am J Med 2004; 116: 385-393.
26. Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA 2000; 283: 749-755.
27. Solomkin JS, Wilson SE, Christou NV, Rotstein OD, Dellinger EP, Bennion RS, et al. Results of a clinical trial of cliprofloxacin versus imipenem/cilastatin for intraabdominal infections. Ann Surg 2001; 233: 79-87.
28. Solomkin JS, Yellin AE, Rotstein OD, Christou NV, Dellinger EP, Tellado JM, et al. Ertapenem versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections: results of a double-blind, randomized comparative phase III trial. Ann Surg 2003; 237: 235-245.
29. Losanoff JE, Richman BW, Jones JW. Temporary abdominal coverage and reclosure of the open abdomen: frequently asked questions. J Am Coll Surg 2002; 195: 105-115.
30. Ferrada R, Birolini D. New concepts in the management of patients with penetrating abdominal wounds. Surg Clin North Am 1999; 79: 1331-1356.
31. Gowna TA. Transplantation. Am J Kidney Dis 2000; 35: S153-S59.
32. Heidenreich PA, McClellan M. Trends in treatment and outcomes for acute myocardial infarction: 1975-1995. Am J Med 2001; 110: 165-174.
33. American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected acute myocardial infarction or unstable angina. Ann Emerg Med 2000; 35: 521-525.
34. Roberts R. Management of patients with infectious diseases in an emergency department observation unit. Emerg Med Clin North Am 2001; 19: 187-207.
35. Uphold CR, Deloria-Knoll M, Palella FJ, Parada JP, Chmiel JS, Phan L, et al. Management of patients with infectious diseases in an emergency department observation unit. Chest 2004; 125: 548-556.
36. Beaujean DJ, Blok HE, Vanderbroucke-Grauls CM, Weersink AJ, Raimakers JA, Verhoef J. Surveillance of nosocomial infections in geriatric patients. J Hospital Infect 1997; 36: 275-284.
37. Hussain M, Oppenheim PA, O'Neill P, Trembath C, Morris J, Horan MA. Prospective survey of the incidence, risk factors and outcome of hospital-aquired infections in the elderly. J Hosp Infect 1996; 32: 117-126.
38. Shortlife LMD, McCue JD. Urinary tract infections at the age extremes: pediatrics and geriatrics. Am J Med 2002; 113(Suppl 1A): 55S-66S.
39. Hartstein AI, Garber SB, Ward TT, et al. Nosocomial urinary tract infection: a prospective evaluation of 108 catheterized patients. Infect Control Hosp Epidemiol 1981; 2: 380-386.
40. Jain P, Parada JP, David A, et al. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995; 155: 1425-1429.
41. Ouslander JG, Greenhold B, Chen S. Complications of chronic indwelling urinary catheters among male nursing home patients: a prospective study. J Urol 1987; 138: 1191-1195.
42. Ouslander JG, Greenhold B, Silverblatt F, et al. External catheter use and urinary tract infection among incontinent male nursing home patients. J Am Geriatr Soc 1987; 35: 1063-1070.
43. Robert M, Boularan AM, Sandid M, Grasset D. Double-J ureteric stents encrustations: clinical study on crystal formation on polyurethane stents. Urol Int 1997; 58: 100-104.
44. Tambyah PA, Halvorson K, Maki DG. A prospective study of the pathogenesis of catheter-associated urinary tract infection. Mayo Clin Proc 1999; 74: 131-136.
45. Garvey BM, McCambley JA, Tuxen DV. Effects of gastric alkalinization on bacterial colonization in critically ill patients. Crit Care Med 1989; 17(211): 16.
46. Marshall JC, Cristou NV, Meakins JL. The gastrointestinal tract: “the undrained abscess” of multiple organ failure. Ann Surg 1993; 218: 211-216.
47. Warren D, Tenney JH, Hoopes JM, et al. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982; 146: 1535-1537.
48. Warren JW, Antony WC, Hoopes JM, et al. Cephalexin for susceptible bacteriuria in afebrile, long-term catheterized patients. JAMA 1982; 248: 454-458.
49. van der Wall E, Verkooyen RP, Mintjes-de Groot J, Oostinga J, van Dijk A, Hustin VWN. Prophylactic ciprofloxacin for catheter - associated urinary tract infection. Lancet 1992; 339: 946-951.
50. Rutschmann OT, Swahlen H. Use of norfloxacin for prevention of symptomatic urinary tract infection in cronically catheterized patients. Eur J Clin Microbiol Infect Dis 1995; 14: 441-444.
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Publicado
2005-09-20
Cómo citar
(1)
García, A.; Duque, P.; Urrutia P., L.; García, A.; Martínez, E. Análisis De Los Factores De Riesgo De infección Del Tracto Urinario Asociada Con Sonda Vesical En La UCI. Rev Colomb Cir 2005, 20, 135-143.
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